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These studies demonstrated that fasting upregulates the plasma membrane OCTN2 carnitine transporter in the liver, heart, kidneys and in rats with strong caloric restriction, additionally in skeletal muscle [111]
It turns out that this can cause relative carnitine deficiency, which can result in lingering fatigue (even after thyroid hormone therapy )
"Randomized double-blind placebo-controlled trial of acetyl-L-carnitine for the prevention of taxane-induced neuropathy in women undergoing adjuvant breast cancer therapy." J Clin Oncol 31(20): 2627-2633
[DOI] [PMC free article] [PubMed] [Google Scholar] 75.Wolff JA, Carroll JE, Le Phuc T, Prodanos C, Haas R, Nyhan WL
